BJR Case Reports最新文献

{"title":"Pathologic fracture: a rare initial manifestation of sarcoidosis.","authors":"Claudine A Vera Cruz, Joshua E Cunningham, Tomy Kalapparambath, Sandeep Grewal","doi":"10.1093/bjrcr/uaag023","DOIUrl":"10.1093/bjrcr/uaag023","url":null,"abstract":"<p><p>Sarcoidosis is a multisystem granulomatous disease that most commonly involves the lungs and intrathoracic lymph nodes. Osseous involvement is uncommon, reported in approximately 1%-14% of cases, and is frequently subclinical or discovered incidentally on imaging. Symptomatic bone involvement as the presenting manifestation of sarcoidosis is rare. In the largest single-center series, only 1 of 20 patients (5%) had osseous disease as the sole manifestation. We describe a 48-year-old man who presented with progressive atraumatic right shoulder pain and was initially suspected to have rotator cuff pathology. MRI instead revealed supraspinatus and infraspinatus tendinitis, multifocal destructive osseous lesions involving the humerus and scapula, and a pathologic scapular fracture. Subsequent FDG PET-CT demonstrated pulmonary and multifocal skeletal hypermetabolic lesions, and CT-guided biopsy of the left iliac crest showed non-caseating granulomas, establishing the diagnosis of sarcoidosis. This case highlights the diagnostic challenge of osseous sarcoidosis when it presents before a known systemic diagnosis and mimics both common shoulder pathology and metastatic disease. It also illustrates the value of advanced imaging and tissue diagnosis in clarifying destructive bone lesions in patients without classic systemic symptoms.</p>","PeriodicalId":45216,"journal":{"name":"BJR Case Reports","volume":"12 3","pages":"uaag023"},"PeriodicalIF":0.6,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13303285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antenatal diagnosis of fetal umbilical hernia on mid-trimester sonography.","authors":"Sreedevi Sathian","doi":"10.1093/bjrcr/uaag020","DOIUrl":"10.1093/bjrcr/uaag020","url":null,"abstract":"<p><p>Congenital hernia of the umbilical cord (CHUC) is a rare and often under-recognized anterior abdominal wall defect that is frequently misdiagnosed as an omphalocele. It represents a distinct embryological entity with a benign course and favorable prognosis. Prenatal ultrasonography is crucial for accurate diagnosis, appropriate parental counseling, and safe perinatal management, particularly to prevent bowel injury during umbilical cord clamping. We report a case of isolated fetal umbilical hernia detected on a routine mid-trimester anomaly scan and highlight key sonographic features that aid differentiation from other abdominal wall defects.</p>","PeriodicalId":45216,"journal":{"name":"BJR Case Reports","volume":"12 3","pages":"uaag020"},"PeriodicalIF":0.6,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13222542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emphysematous pyelonephritis with perinephric extension and fistulous communication to the descending colon: a rare CT imaging diagnosis.","authors":"Shweta Gaikwad, Eshan Thotwe","doi":"10.1093/bjrcr/uaag022","DOIUrl":"10.1093/bjrcr/uaag022","url":null,"abstract":"<p><p>Emphysematous pyelonephritis (EPN) is a severe necrotizing infection characterized by gas formation within the renal parenchyma and surrounding tissues. Although perinephric extension is well recognized, fistulous communication with the adjacent bowel is exceedingly rare. We report a case of a 58-year-old woman presenting with fever, left flank pain, uncontrolled diabetes mellitus, and acute kidney injury. Initial non-contrast CT KUB showed left EPN with a large perinephric air-containing collection and loss of fat planes with the adjacent descending colon, raising suspicion of a reno-colic fistula. Following DJ stenting, a repeat CT scan with administration of rectal contrast demonstrated direct contrast leakage into the perinephric collection, confirming fistulous communication. Subsequent colonoscopy corroborated the imaging findings. This case highlights the importance of sequential CT imaging and the role of rectal contrast in confirming rare fistulous complications of EPN.</p>","PeriodicalId":45216,"journal":{"name":"BJR Case Reports","volume":"12 3","pages":"uaag022"},"PeriodicalIF":0.6,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13234444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic pseudolymphoma with hepatobiliary-phase ring-like hyperintensity on gadoxetic acid-enhanced MRI: radiologic-pathologic correlation with intratumoral fibrosis.","authors":"Shuji Nagata, Nona Fujimoto, Tatsuyuki Tonan, Tomonori Chikasue, Akiko Sumi, Jun Akiba, Shuichi Tanoue","doi":"10.1093/bjrcr/uaag021","DOIUrl":"10.1093/bjrcr/uaag021","url":null,"abstract":"<p><p>Hepatic pseudolymphoma (HPL) is a rare benign lymphoproliferative disorder that can mimic malignant hepatic tumors on imaging. Hepatic pseudolymphoma is usually small and solitary; however, multiple lesions can develop in some cases. Herein, we report multiple HPLs with an unusual hepatobiliary finding on gadoxetic acid-enhanced MRI. A woman in her 50 s with non-alcoholic fatty liver disease was incidentally found to have 2 hepatic tumors: a 3-cm lesion in segment 5 (S5) and a 1-cm lesion in segment 8 (S8) during pre-operative cholelithiasis evaluation. The laboratory tests, including liver function and tumor marker levels, were unremarkable. The 2 lesions were hyperintense on fat-suppressed T2-weighted images and showed restricted diffusion. On dynamic gadoxetic acid-enhanced MRI, both lesions demonstrated faint arterial enhancement and hepatobiliary-phase hypointensity, with peritumoral arterial-phase hyperenhancement. Additionally, the S5 lesion showed faint linear hyperintensity adjacent to the lesion on diffusion-weighted imaging and contained an internal ring-like area that was hypointense on T2-weighted images but hyperintense within an otherwise hypointense lesion in the hepatobiliary phase. As malignancy could not be excluded, laparoscopic anterior sectionectomy was performed. Histopathological examination confirmed reactive lymphoid hyperplasia in both lesions. In the S5 lesion, the intratumoral fibrotic tissues formed a ring-like structure corresponding to the hepatobiliary-phase hyperintensity. Hepatobiliary-phase ring-like hyperintensity attributable to intratumoral fibrosis in HPL has not been previously reported. Awareness of this imaging-pathology correlation may improve interpretation of HPL imaging and help differentiate it from malignant hepatic tumors that can show hepatobiliary-phase hyperintensity, including hepatocellular carcinoma, cholangiocarcinoma, and metastases.</p>","PeriodicalId":45216,"journal":{"name":"BJR Case Reports","volume":"12 3","pages":"uaag021"},"PeriodicalIF":0.6,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13235740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral fat embolism treated with mechanical embolectomy: case report and systematic review of the literature.","authors":"Rohan Mudkavi, Tatyana Sarnecki, Ei Ei Phyu, Htet Phyo Than, Veronica Phillips, Naeem Ahmad, Smriti Agarwal, Yogish Joshi, Dilina Rajapakse, Abhishekh H Ashok","doi":"10.1093/bjrcr/uaag019","DOIUrl":"10.1093/bjrcr/uaag019","url":null,"abstract":"<p><p>Cerebral fat embolism (CFE) is a rare complication of orthopaedic, cardiac and plastic surgery and major trauma. Mechanical embolectomy has been used as a treatment option for this condition. Here, we described a case report of an elderly woman who developed CFE after a total hip replacement which was treated with mechanical embolectomy with aspiration alone. The patient developed left-sided hemiparesis and abnormal posturing after surgery and a CT angiogram 45 minutes later showed a right M1 embolus with fat attenuation. Mechanical embolectomy with aspiration was conducted to produce a TICI score of 3. No patent foramen ovale (PFO) was found to explain the paradoxical embolism. Subsequently, a systematic literature review on the use of mechanical embolectomy for CFE was conducted, with the databases Medline, Web of Science, Embase, Cinahl, and Scopus being searched. The review found 20 cases, 13 of which were treated with aspiration and a stent retriever, and 5 of which were treated with aspiration only. A reduced mortality was observed in the aspiration only cohort compared to the aspiration plus stent retriever cohort, despite both groups having similar age and gender. Among patients treated with stenting, 3 out of 13 (23%) died, compared to 0 out of 5 (0%) patients treated with aspiration alone. Although this difference was not statistically significant, it may reflect a trend worth further exploration, potentially limited by the small sample size. Further registry-based studies and preclinical models are required to elucidate the effectiveness and superior technique of mechanical embolectomy for CFE.</p>","PeriodicalId":45216,"journal":{"name":"BJR Case Reports","volume":"12 3","pages":"uaag019"},"PeriodicalIF":0.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13198375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complex transsphincteric ano-rectal fistula with circumferential perirectal abscess and periprostatic extension: the added value of contrast-enhanced pelvic MRI.","authors":"Chi Phong Nguyen, Quang Huy Huynh","doi":"10.1093/bjrcr/uaag018","DOIUrl":"10.1093/bjrcr/uaag018","url":null,"abstract":"<p><p>Complex perianal fistulas can harbor extensive secondary extensions and pelvic sepsis despite minimal systemic symptoms and normal inflammatory markers, creating a high risk of incomplete surgery when anatomy is underestimated. We report a case of a complex transsphincteric fistula (Parks classification) with suspected supralevator involvement in which preoperative MRI provided decisive anatomic mapping for operative planning. Multiplanar T2-weighted imaging delineated the primary tract, its relationship to the sphincter complex and levator plate, and extension into the ischioanal/ischiorectal fossae, while also demonstrating features consistent with secondary tracts and occult abscesses-findings that commonly explain postoperative persistence or recurrence if missed. Notably, gadolinium-enhanced fat-suppressed T1-weighted sequences increased conspicuity of subtle distal rectal communications that were poorly visualized on T2-weighted images, supporting the utility of contrast in selected scenarios to distinguish enhancing active tracts/abscess walls from surrounding inflammatory edema or fibrosis. Given concomitant distal rectal ulceration on endoscopy, an inflammatory bowel disease work-up was considered to exclude fistulizing Crohn's disease, for which careful staging of perianal sepsis and combined medical-surgical management are recommended. This case highlights the value of MRI (including contrast-enhanced protocols when indicated) as a preoperative adjunct to examination under anesthesia, enabling tailored, sphincter-preserving strategies and comprehensive sepsis control in complex fistulizing disease.</p>","PeriodicalId":45216,"journal":{"name":"BJR Case Reports","volume":"12 3","pages":"uaag018"},"PeriodicalIF":0.6,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrapulmonary course of the inferior vena cava: a rare congenital anomaly.","authors":"Pietro Sergio, Daniele Distefano, Riccardo De Marchi, Ilaria Zangrandi, Giorgia Maretto, Giulia D'incerto, Salvatore Golemi, Tiziana Guarneri, Margherita Muri, Pietro Ciolli, Giuseppe Voltini, Lorenza Carnevale, Gianluca Romeo","doi":"10.1093/bjrcr/uaag017","DOIUrl":"10.1093/bjrcr/uaag017","url":null,"abstract":"<p><p>Congenital anomalies of the inferior vena cava (IVC) are often encountered incidentally in cross sectional imaging modalities. The most frequently described anomalies include retroaortic left renal vein, left IVC, double IVC, circumaortic left renal vein, interruption of IVC with azygos and hemiazygos continuation, absence of the infrarenal IVC, and circumcaval ureter. This report shows an unusual case of congenital inferior vena cava anomaly, characterized by an intrapulmonary course of the inferior vena cava.</p>","PeriodicalId":45216,"journal":{"name":"BJR Case Reports","volume":"12 3","pages":"uaag017"},"PeriodicalIF":0.6,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic dilemma: a large pancreatic lipoma initially misdiagnosed as liposarcoma on CT imaging.","authors":"Saeed Mohammadzadeh, Alisa Mohebbi, Afshin Mohammadi, Ata Abbasi, Rahim Mahmodlou","doi":"10.1093/bjrcr/uaag013","DOIUrl":"10.1093/bjrcr/uaag013","url":null,"abstract":"<p><p>Pancreatic lipomas are exceptionally rare benign mesenchymal tumors that may closely resemble well-differentiated liposarcomas on imaging, particularly when large or atypical. We report the case of a 60-year-old man who presented with abdominal pain, nausea, and vomiting, and was found to have a large fat-containing mass in the pancreatic head on computed tomography. Imaging characteristics-including size, mild heterogeneity, and a cystic component-raised strong suspicion for a well-differentiated liposarcoma. Due to diagnostic uncertainty and potential oncologic risk, the patient underwent a pancreaticoduodenectomy (Whipple procedure). Histopathological evaluation revealed a benign pancreatic lipoma composed of mature adipocytes without atypia or lipoblasts. This case highlights the diagnostic limitations of imaging in differentiating benign from malignant fat-containing pancreatic lesions and underscores the essential role of histopathology for definitive diagnosis. Surgical resection remains crucial when imaging is inconclusive or when malignancy cannot be confidently excluded.</p>","PeriodicalId":45216,"journal":{"name":"BJR Case Reports","volume":"12 3","pages":"uaag013"},"PeriodicalIF":0.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13163157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IgG4-related retroperitoneal fibrosis mimicking perinephric extension of renal cell carcinoma on CT: a case report.","authors":"Alvin J Logronio, Marta Prieto-Suárez, José Antonio Ortiz-Rey, Milagros Otero-García","doi":"10.1093/bjrcr/uaag016","DOIUrl":"10.1093/bjrcr/uaag016","url":null,"abstract":"<p><p>Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition that can closely mimic malignancy on imaging. IgG4-related retroperitoneal fibrosis (RPF) most commonly involves the para-aortic or peri-iliac regions, while focal perinephric involvement is uncommon. Accurate differentiation from true perinephric tumour extension is critical, as misinterpretation may substantially alter renal cell carcinoma (RCC) staging and management. A 41-year-old man undergoing contrast-enhanced CT for transient rectal bleeding was incidentally found to have a heterogeneously enhancing left renal mass suspicious for RCC, with adjacent unilateral irregular perinephric soft tissue extending beyond Gerota's fascia. On CT, these findings were interpreted as locally advanced cT4 RCC. Radical nephrectomy was performed. Histopathology demonstrated clear cell RCC, grade 2, confined to the kidney (pT1b), with intact renal capsule and no perinephric or lymphovascular invasion. The adjacent perinephric tissue instead showed storiform fibrosis, dense IgG4-positive plasma cell infiltrates, and obliterative phlebitis, consistent with IgG4-related RPF. Serum IgG4 was mildly elevated. Postoperative FDG PET/CT demonstrated a focal hypermetabolic perinephric lesion without systemic involvement, and both imaging and serologic findings improved following corticosteroid therapy. This case highlights a rare but important radiologic pitfall in which focal perinephric IgG4-related RPF was radiologically indistinguishable from perinephric RCC extension, resulting in initial overstaging. IgG4-RD should be considered in the differential diagnosis when perinephric soft tissue appears inseparable from a renal mass, and multimodal evaluation integrating imaging, pathology, and serology is essential to avoid overstaging and inappropriate management.</p>","PeriodicalId":45216,"journal":{"name":"BJR Case Reports","volume":"12 3","pages":"uaag016"},"PeriodicalIF":0.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete abdominal aortic occlusion following seat-belt trauma: a proposal for early recognition.","authors":"Antonio Galluzzo, Fabio Lampis, Chiara Esposito, Diletta Cozzi, Riccardo Ferrari, Michele Galluzzo, Vittorio Miele","doi":"10.1093/bjrcr/uaag015","DOIUrl":"10.1093/bjrcr/uaag015","url":null,"abstract":"<p><p>Post-traumatic abdominal aortic occlusion (PTAO) is an extremely rare but potentially fatal consequence of high-energy blunt trauma, particularly in the setting of seat-belt injury. While thoracic aortic injuries are more commonly reported, complete occlusion of the abdominal aorta remains poorly documented, with only a few case reports available in the literature. We present two cases of seat-belt-associated PTAO, both evaluated with contrast-enhanced computed tomography (CECT), highlighting the importance of early recognition and tailored imaging protocols in polytrauma scenarios. In both cases, the aortic injury was located at the level of L3, anatomically aligned with vertebral fractures, supporting a direct traumatic mechanism. One patient underwent emergent surgical repair but succumbed to complications, while the other was successfully treated with an endovascular approach and remained stable at one-year follow-up. Key diagnostic features included sudden absence of aortic opacification, absence of vascular calcifications, and lack of collateral circulation, helping distinguish acute PTAO from chronic conditions such as Leriche syndrome. Our findings emphasize the need for radiologists and emergency clinicians to maintain a high index of suspicion for PTAO in patients with seat-belt injuries and vertebral fractures. Prompt diagnosis using CECT can guide urgent therapeutic decisions and improve patient outcomes. This report adds to the limited literature on abdominal aortic injury following blunt trauma and proposes practical imaging criteria for early detection.</p>","PeriodicalId":45216,"journal":{"name":"BJR Case Reports","volume":"12 2","pages":"uaag015"},"PeriodicalIF":0.6,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13117600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}